CRITICAL APPRAISAL
Abstract
Psoriasis is an inflammatory skin condition. Studies suggest that there is a close relationship between psoriasis and mild onset depression and an estimated 2-3 % of the overall Caucasian population is likely to suffer from psoriasis. Psoriasis affects an individual’s physical appearance and as a result potentially causing stigmatization and social isolation. Once an individual faces social isolation, the elevated stress levels are likely to result in stress-related medical conditions such as depression and anxiety. The increased levels of chronic depression and metabolic commodities in psoriasis patients is also a potential causative agent for depression in persons suffering from psoriasis. To estimate the occurrence of depression in patients suffering from psoriasis a meta-analysis was conducted and results analyzed using Stata and SAS software to ensure results accuracy. The sample size results show that patients diagnosed with psoriasis are at an elevated rate of suffering from depression compared to the general public and that young patients with server psoriasis are more likely to be diagnosed with depression compared to any other group.
Critical Appraisal for Cohort Danish psoriasis and new-onset depression Study
Validity
The cohort study results on psoriasis and new-onset depression are analyzed based on (Fineout & B, 2018) critical appraisal methodology. The Danish cohort study results in psoriasis and new-onset depression is valid. This is because the study uses a representative study population that comprises of 5,216,826 individuals above the age of 18 years. The cohort study further includes the entire Danish population and sample size selection was not based on gender, age, labour force participation, or individual insurance status. The large sample size used as well as the population diversity is useful at minimizing results bias. The study population is also well characterized based on the distribution of depression, mild psoriasis, and server depression to critically evaluate the incidence of depression in individuals diagnosed with psoriasis. There is however a potential miss-classification of psoriasis patient as the general population in incidence where psoriasis patients were not under pharmaceutical pharmacological drugs or were using topical ointments. The misclassification of psoriasis patients as a general population may have affected the outcome of the results by resulting in the underestimation of psoriasis as a depression causative condition. Information on the study sample size was also obtained from recorded Danish registries to ensure data accuracy and minimizes potential disadvantages linked to questionnaires when conducting psychosocial analysis to diagnoses incidences of depression in psoriasis patients. The qualitative approach used to investigate the incidence of depression in psoriasis patients. Further contributes to the validity of the data through increasing the replicability of results obtained beyond the Danish population setting.
The cohort study follow-up is sufficient and complete with a maximum follow-up period between 2001 and 2011. In the event of death, a mortality rate of per 1000 persons with a confidence level of 95 % was considered and the variables adjusted based on poison- regression models. The study also excluded patients previously diagnosed with depression at a baseline level and study participants were adjusted for the incidence of depression.
The study has also made use of objective measures. Outcomes of death are also objectively studied based on judgment and calculated based on poison regression models. Prognosis factors were also considered at baseline to help assess liberal judgment outcomes such as individuals suffering from rheumatoid conditions were excluded to obtain objective outcomes. The study made use of data obtained from the registries to avoid obtaining subjective data obtained from individual patients and as a result minimizing potential bias from the study participants to provide a more reliable result.
The Danish cohort study data results categorized patients based on the severity of psoriasis and incidence rates calculated based on whether psoriasis was mild or severe. The patient sample size was well defined and patients with depression/psoriasis excluded at a baseline level to improve data accuracy. Patients with rheumatoid diseases were also excluded from the analysis and results compared to the primary analysis. The comparison analysis indicated no significant variation to primary analysis however, no rheumatoid disease exclusion results were provided.
Reliability
The Danish nationwide cohort study result indicates an increased incidence of antidepressant drug prescription exists in individuals with severe and mild psoriasis when compared to individuals not affected with psoriasis (Jensen et al., 2016). The Danish cohort meta-analysis studies further indicated that individuals diagnosed with psoriasis have a 1.5 likelihood of experiencing depression when compared to the general public. The meta-analysis results were further interpreted with a 25% rate of potential depression incidence in psoriasis patients. The sample size depression incidence rate per 1000 persons is 20 with a 95% confidence interval of 19.9-20.0 among the control population while a 23.9 incidence rate was obtained from a 95% confidence interval of 23.1-24.7 in mild psoriasis and finally in server psoriasis had an incidence rate of 31.6 from a 95% CI of 29.5-33.8. The adjusted incidence rate ratios were 20.0 (95% CL 19.9–20.0) for the general population, 31.6 (95% CL 29.5–33.8), and 23.9 (95% CL 23.1–24.7) for patients with severe psoriasis respectively and mild psoriasis.
The study estimates within the study sample size are accurate and a 95% confidence interval is used. The 95% confidence interval is used to examine the study results true mean ideal values within the sample size population. The p values obtained further increases the replicability of results obtained to other clinical settings to develop a patient-centered approach designed to diagnose and reduce the occurrence of depression in psoriasis patients. During the study, A 2- sided < 0.05 p-value was considered and the p-value was statistically used to provide an age-stratified IRR to evaluate the relationship between age and psoriasis. Also, the sample results were evaluated using SAS and Stata software to ensure results accuracy. Also, the sample results were investigated using SAS certified software and Stata software to ensure results accuracy (Jensen et al., 2016).
The study results are easily transferrable and applicable in a clinical setting involving psoriasis patients below the age of 50 years. The study results indicate that young patients with server psoriasis are more predisposed to depression. The study results can, therefore, be used in developing a patient-centered care approach designed to help psoriasis patients deal with depression. The study population is non-discriminative based on age gender, insurance status, and labour force market placement and as a result, it is likely to have a patient sample size similar to the patients in my clinical settings. However, in incidences where children and young adults are affected by psoriasis, the Danish cohort study is not directly applicable to clinical settings involving minors as the sample study population involved a sample size population of 18 years and above.
Whether or not the study results may be used indirectly selecting therapy is not known and this mainly because the study does not give any recommendations to therapies useful in treating patients however, the study may prove useful in-patient centered care. Considering the high incidence rate of depression in psoriasis patients, the study proves useful in predicting the possibility of depression in psoriasis patients, and as such this may help the medical practitioner to offer much-needed counsel to psoriasis patents as they are likely to face social isolation and stigmatization.
In conclusion, patients diagnosed with psoriasis are at an increased rate of suffering from depression compared to the general public and such patients are easily present in clinical settings and as such the identification of such patients with symptoms of depression when diagnosis and treating psoriasis may prove useful in preventing and treating depression to prevent mortality arising from increased suicides(Wu et al., 2017). Future prospective studies incorporating the use of topical ointments to treat psoriasis and use of alternative therapies.
Reference
Fineout-Overholt, B.M.M. E. (2018). Evidence-Based Practice in Nursing & Healthcare. A [VitalSource Bookshelf]. Retrieved from https://bookshelf.vitalsource.com/#/books/9781496386892/
Jensen, P., Ahlehoff, O., Egeberg, A., Gislason, G., Hansen, P. R., & Skov, L. (2016). Psoriasis and new-onset depression: a Danish nationwide cohort study. Acta dermato-A venereologica, 96(1), 39-42.
Wu, J. J., Penfold, R. B., Primatesta, P., Fox, T. K., Stewart, C., Reddy, S. P., … & Simon, G. (2017). The risk of depression, suicidal ideation, and suicide attempt in patients with psoriasis, psoriatic arthritis, or ankylosing spondylitis. Journal of the European Academy of Dermatology and Venereology, 31(7), 1168-1175.